hypoglycaemia

kitedoc

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I note the How To Treat A Hypo information. As a T1D for 58 years I have a 'passing familiarity' with hypos. What concerns me is that:
a) whilst glucose is listed as the first option for treatment, the next options are 'fizzy drinks, sweets and fruit juice'.
From past clinical experience and my diabetes education, these later options contain sucrose,(table sugar) which the saliva in our mouth
usually breaks down to glucose and fructose (fruit sugar). The glucose is needed to raise our BGLs but the fructose does not of itself raise
blood glucose levels. Fruit juices also contain levels of fructose and over many years the cultivation of fruit has led to higher levels in fruit.
What is worse, such rapidly absorbed fructose is coped with by liver the same way alcohol is - by being turned into fat, and stored in the liver.
Fructose is sometimes referred to as children's alcohol, you get the liver problems like fatty liver , just not with alcohol itself.
You might ask, but what does it matter having sucrose as a hypo remedy on one occasion?
But, how many hypos can happen in a day, a week or a month? - with T1D as a child like I was - how many typos and treatments over years?
Fortunately for me now on a very low carb diet, hypos are rare and mild, and I have routinely used glucose for hypos except on the very rare
occasion where I have run out, it got wet and dissolved etc. Then any glucose such as in the other portions mentioned above is a last resort.
But, as Dr Bernstein states (paraphrased), 'the most usual cause of hypoglycaemia is from high carb diets requiring industrial doses of insulin'
b) If I suffer a rebound high BGL from treating a hypo, or a high BGL for any reason above 7 mmol/l, this leads to a biochemical sequence called the
POYOL pathway - whereby 30% of that BGL is converted to fructose whereas under 7 mmol/l the amount of BGL converted to fructose is only 3 to 5%.
What can fructose from a) or b) do beyond the developing of fatty liver - the other complications associated with repeated exposure to fructose
include damage to the back of the eyer (retina), cataracts in the lenses of the eye, damage to kidneys and nerves.
If you think that a BGL of 7 mmol/l just comes and goes, there is a equivalence chart of average BGL vs HBA1c - two derivations 1) from the Diabetes
Control and Complications Trial (DCCT) and another made up by a committee of the ADA and commercial interest titled the ADAG. see diagram.
An average BGL of 7 mmol/l = 5.7% (DCCT) or about 6% (ADAG). Please think about that the next time you see the official recommnedatons for HBA1c !!

/Users/tonysangster/Desktop/IMG_2500.jpeg
 

Tony337

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"only in mathematics will you find the truth"

Am i right in thinking if you consume too much fructose there is a potential of organ damage?

I have never aimed for a low sugar level nor have i passed out or been hospitalised in 50 years of type 1 diabetes but my control is lower than its ever been at 39 or 5.7 but there is obviously a greater risk of a low blood sugar (i do not use the word hypo for reasons i won't go in to ).

Do i need to give more thought on what i use to deal with a low?

Is fructose that dangerous?

Interesting.....

Thank you

Tony
 

Jaylee

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I note the How To Treat A Hypo information. As a T1D for 58 years I have a 'passing familiarity' with hypos. What concerns me is that:
a) whilst glucose is listed as the first option for treatment, the next options are 'fizzy drinks, sweets and fruit juice'.
From past clinical experience and my diabetes education, these later options contain sucrose,(table sugar) which the saliva in our mouth
usually breaks down to glucose and fructose (fruit sugar). The glucose is needed to raise our BGLs but the fructose does not of itself raise
blood glucose levels. Fruit juices also contain levels of fructose and over many years the cultivation of fruit has led to higher levels in fruit.
What is worse, such rapidly absorbed fructose is coped with by liver the same way alcohol is - by being turned into fat, and stored in the liver.
Fructose is sometimes referred to as children's alcohol, you get the liver problems like fatty liver , just not with alcohol itself.
You might ask, but what does it matter having sucrose as a hypo remedy on one occasion?
But, how many hypos can happen in a day, a week or a month? - with T1D as a child like I was - how many typos and treatments over years?
Fortunately for me now on a very low carb diet, hypos are rare and mild, and I have routinely used glucose for hypos except on the very rare
occasion where I have run out, it got wet and dissolved etc. Then any glucose such as in the other portions mentioned above is a last resort.
But, as Dr Bernstein states (paraphrased), 'the most usual cause of hypoglycaemia is from high carb diets requiring industrial doses of insulin'
b) If I suffer a rebound high BGL from treating a hypo, or a high BGL for any reason above 7 mmol/l, this leads to a biochemical sequence called the
POYOL pathway - whereby 30% of that BGL is converted to fructose whereas under 7 mmol/l the amount of BGL converted to fructose is only 3 to 5%.
What can fructose from a) or b) do beyond the developing of fatty liver - the other complications associated with repeated exposure to fructose
include damage to the back of the eyer (retina), cataracts in the lenses of the eye, damage to kidneys and nerves.
If you think that a BGL of 7 mmol/l just comes and goes, there is a equivalence chart of average BGL vs HBA1c - two derivations 1) from the Diabetes
Control and Complications Trial (DCCT) and another made up by a committee of the ADA and commercial interest titled the ADAG. see diagram.
An average BGL of 7 mmol/l = 5.7% (DCCT) or about 6% (ADAG). Please think about that the next time you see the official recommnedatons for HBA1c !!

/Users/tonysangster/Desktop/IMG_2500.jpeg

Fascinating post.

It’s safe to say the key to reducing hypoglycaemic events is basal testing & understanding insulin to carb ratio.

I have read fructose from juice could contribute to NAFLD.
but in my decades of experience treating lows, especially since the advent of CGMs giving advanced warning coupled with the above balance of insulin dose.
I’ve not needed the blanket recommendational amount advised to treat an event?

I tend to favour milk if it’s nudging an off basal dose anyway…
 

Grant_Vicat

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Good to see you again @kitedoc ! I am a little bemused by these findings, not because of the scientific information, but because of personal experience.
From 1959 I used glucose tablets (which I hated!) Lucozade, or Ribena. Smetime in my 20s I started using whatever was to hand, which was most likely to be sucrose based. Probably 30 years ago I discovered by chance that Pineapple juice brought me back to my senses quicker than any other source. I cannot explain the science and it may be due to individual metabolism. I waved goodbye to Type1 in 2013 and I still eat fruit every day. Because of immunosuppressant complications I have undergone a comprehensive battery of tests but the one clear finding is that my organs, including the transplanted kidney and pancreas, are in great condition and show no signs of fatty liver. I must admit that I was relieved to hear this! I guess it's like we can usually name someone who smokes, drinks and whose diet is far from recommended by nutritionists and yet they are in their nineties!
 

CheeseSeaker

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Might be missing the point here - Glucose fastest through the intestine into the blood stream as no digestion (fastest fix), but used quickly in the body so following crash if no-backup slow digesting carbs can happen.

In a perfect world - no or few low BG events that need treatment - in reality are people consuming enough fruit or sugary drinks to cause that big an issue (compared with the other issues of diet and diabetes, like overeating, hyper glycemia etc)?

Most of us find our own way through it, and find a practical solution (I tend to have a 500ml bottle of Lucozade sport on the side in the kitchen (till I either drink it, or penicillin grows on the surface) - Fruit juice wouldn't last long enough....
 

Jaylee

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Might be missing the point here - Glucose fastest through the intestine into the blood stream as no digestion (fastest fix), but used quickly in the body so following crash if no-backup slow digesting carbs can happen.

In a perfect world - no or few low BG events that need treatment - in reality are people consuming enough fruit or sugary drinks to cause that big an issue (compared with the other issues of diet and diabetes, like overeating, hyper glycemia etc)?

Most of us find our own way through it, and find a practical solution (I tend to have a 500ml bottle of Lucozade sport on the side in the kitchen (till I either drink it, or penicillin grows on the surface) - Fruit juice wouldn't last long enough....
I’m somewhat confused too…

I could understand the caution regarding anyone who’s a massive juicer? (There have been mentions regarding the possible causation of Non Alcoholic Fatty Liver Disease?)

I don’t always use fruit juice for lows, but on the rare occasion I have no more than 50ml.
 

SimonP78

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Am i right in thinking if you consume too much fructose there is a potential of organ damage?

No. Too much glucose is the issue, not too much fructose.

When the excess glucose is converted to fructose (via the polyol pathway) it also produces sorbitol and this sorbitol is what is thought to be involved in damaging things: https://en.wikipedia.org/wiki/Polyol_pathway

I do agree that using sucrose to treat hypos is providing "empty" (not useful in raising blood glucose) calories, however as long as one accepts this and isn't trying to lose weight then I think it's fine. Personally try to chose something I'd like to eat and and probably wouldn't otherwise bother with as it would require extra insulin on a normal day - these things are almost always non-optimal from an absorption point of view and certainly from an "empty calories" point of view. But they taste nice :) - chocolate, cake, vanilla milk, etc.
 
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Grant_Vicat

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these things are almost always non-optimal from an absorption point of view and certainly from an "empty calories" point of view. But they taste nice :) - chocolate, cake, vanilla milk, etc.
As you say @SimonP78 "non-optimal" applies to chocolate and any milk that isn't skimmed. I remember doing exactly this! But for other readers it's worth pointing out that chocolate, to say the least, is fatty and slows down absorption considerably. A chocolate bar will work eventually, but the delay can cause even more wolfing down of sweet food in order to regain a higher blood glucose level.
 

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As you say @SimonP78 "non-optimal" applies to chocolate and any milk that isn't skimmed. I remember doing exactly this! But for other readers it's worth pointing out that chocolate, to say the least, is fatty and slows down absorption considerably. A chocolate bar will work eventually, but the delay can cause even more wolfing down of sweet food in order to regain a higher blood glucose level.
On the other hand, while glucotabs and the likes will work faster, I also hate them with a vengeance and lows make me pretty stubborn and not wanting to eat, even if I know I must. So chocolate works better for me because I'd at least eat it. :hilarious:
I absolutely love treating hypos with a bit of fruit when I get the chance, and I'm not worried that the occasional half mandarin orange or a couple of grapes will give me fatty liver disease.
 

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On the other hand, while glucotabs and the likes will work faster, I also hate them with a vengeance and lows make me pretty stubborn and not wanting to eat, even if I know I must. So chocolate works better for me because I'd at least eat it. :hilarious:
I absolutely love treating hypos with a bit of fruit when I get the chance, and I'm not worried that the occasional half mandarin orange or a couple of grapes will give me fatty liver disease.
Agreed @Antje77 I am only trying to point out that fat candelay absorption - something which took me years to realise. Enjoy the chocolate!
 
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Fairygodmother

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Our local shop sells packets of liquorice allsorts and each sweet is approx 5g carb. Hypo treatment treat. No, no deliberate hypos to get a fix and I bet your liquorice is better, Antje.
 
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Antje77

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Agreed @Antje77 I am only trying to point out that fat candelay absorption - something which took me years to realise. Enjoy the chocolate!
Chocolate hardly ever happens for a hypo, sadly. Toxic to dogs so I don't carry any, and my 90% cocoa chocolate is safely in a closed box because dogs, and it wouldn't do anything for a hypo anyway.
Our local shop sells packets of liquorice allsorts and each sweet is approx 5g carb. Hypo treatment treat. No, no deliberate hypos to get a fix and I bet your liquorice is better, Antje.
In my bag I tend to alternate winegum type treats and liquorice (but definitely not allsorts, which is called 'Engelse drop' in Dutch).
Yes, our liquorice is better, especially the salty stuff, but I've learnt not to choose the chewier ones to treat a hypo, chewing is hard work and it delays the action. And liquorice is slower than winegums to start with.

I would never deliberately dose a little too much in hopes on a fix of liquorice or fruit of course. :angelic: :hilarious:
(How did you know???)
 
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Fairygodmother

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Chocolate hardly ever happens for a hypo, sadly. Toxic to dogs so I don't carry any, and my 90% cocoa chocolate is safely in a closed box because dogs, and it wouldn't do anything for a hypo anyway.

In my bag I tend to alternate winegum type treats and liquorice (but definitely not allsorts, which is called 'Engelse drop' in Dutch).
Yes, our liquorice is better, especially the salty stuff, but I've learnt not to choose the chewier ones to treat a hypo, chewing is hard work and it delays the action. And liquorice is slower than winegums to start with.

I would never deliberately dose a little too much in hopes on a fix of liquorice or fruit of course. :angelic: :hilarious:
(How did you know???)

I’ve bought Dutch liquorice in Amsterdam, and from someone who brought it over to the U.K. the salted one, I agree, is delicious! Much better than Englese drops. The best English liquorice is a genuine Pontefract Cake. Hard to get hold of these days.
 
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Tony337

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try to chose something I'd like to eat and and probably wouldn't otherwise bother with as it would require extra insulin on a normal day -
Side tracking but refusing food because it would mean me taking insulin........is a very simple thought process but most non diabetics don't get it.

Getting a wriggle on to try to help get my insulin working quicker is another one....

Happy monday

Tony
 
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SimonP78

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Side tracking but refusing food because it would mean me taking insulin........is a very simple thought process but most non diabetics don't get it.

Getting a wriggle on to try to help get my insulin working quicker is another one....

Happy monday

Tony
Indeed, it's probably quite a good way of avoiding eating things that aren't very good for me, knowing I'll need to deal with the aftermath, but it does mean I also suffer from the problem of trying to select which of these delightful things I should eat to treat my hypo, all the while getting lower and lower.

To avoid this problem, and it is a real problem, I have selected some nice tasting chocolates which I will immediately and happily eat.

Completely agree with what you said @Grant_Vicat - perhaps my "non optimal" was too reserved - for those reading don't do as I do, eat something faster acting. E.g. If I'm in the car or out and about and need to raise BG I'll eat Skittles (which are sucrose, but also taste nice enough that I'm happy to consume them, though I'd not normally eat something so sweet out of choice.)
 
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